TSH AND HIGHER THROMBUS BURDEN Published online before print Blood thrombogenicity is independently associated with serum TSH levels in post non ST elevation acute coronary syndrome Context: Higher serum TSH levels, both within the reference range and in those with subclinical hypothyroidism (SCH), have been associated with increased risk of atherosclerosis and cardiovascular (CV) events in a number of cross-sectional and longitudinal studies. Objective: to evaluate blood thrombogenicity (BT) in patients post non-ST elevation acute coronary syndrome (NSTE-ACS) with relation to their thyroid function. Design, patients and outcome measure: Seventy patients one week after troponin positive NSTE-ACS who had been treated with optimal antiplatelet and secondary prevention therapy were studied. Patients with known thyroid disease or on medications affecting thyroid function were excluded. BT was assessed using the ex-vivo Badimon perfusion chamber. Results: Serum TSH was associated with higher thrombus burden (β=0.30; p=0.01) independent of other well-established CV risk factors. Patients with SCH (n=12; 17%) had a higher thrombus burden than euthyroid individuals as evidenced by the area of the thrombus: mean (SD) [23,608 (10,498) vs 16,661 (10,902) μ 2/mm, p=0.02]. However, this association was not evident when the analysis was limited to patients with serum TSH within the reference range. In addition, neither serum free T4 nor free T3 had any significant association with thrombus area. Conclusion: Serum TSH levels, particularly in the subclinical hypothyroid range, are associated with higher thrombus burden despite optimal recommended secondary prevention therapy following NSTE-ACS. This may explain the higher CV risk seen in SCH patients. Future trials to assess the effect of individualised anti-thrombotic as well as thyroid hormone replacement therapy to reduce atherothrombotic risk in this population are needed.
Posted on: Sun, 27 Apr 2014 03:31:02 +0000
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